title: Post-operative epidural analgesia with low dose fentanyl, adrenaline and bupivacaine in children after major orthopaedic surgery. A prospective evaluation of efficacy and side effects.
abstract: The efficacy and side effects of 100 lumbar epidural treatments with low concentrations of bupivacaine (1 mg mL-1), fentanyl (2 micrograms mL-1) and adrenaline (2 micrograms mL-1) combined with rectal paracetamol were prospectively evaluated in children aged 4-14 years after femoral osteotomy. The mean treatment time was 43 h and the mean dose was 0.18 mL kg-1 h-1. Ninety-nine per cent of the children were either without pain or experienced very low pain at rest for at least 80% of the treatment time. The same was the case in 80% of children when pain evaluation was made on active movement. No cases of seizures, signs of catheter migration, hypotension or respiratory depression were observed. Sixty-three per cent of the patients experienced nausea or vomiting, but antiemetic treatment was indicated in only 11%. One epidural treatment had to be stopped in a child who did not respond to antiemetics. The incidence of pruritus was high (49%), but the symptoms were mild and limited.
authors.affiliation: Department of Anaesthesiology, Ullevaal University Hospital, Oslo, Norway.
authors.forename: R Z
authors.initials: RZ
authors.lastname: Løvstad
authors.forename: P
authors.initials: P
authors.lastname: Halvorsen
authors.forename: J C
authors.initials: JC
authors.lastname: Raeder
authors.forename: P A
authors.initials: PA
authors.lastname: Steen
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000009:adverse effects / Q000627:therapeutic use*; D002045:Bupivacaine / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005269:Femur / Q000601:surgery; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D010027:Osteotomy; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D005283:Fentanyl; D002045:Bupivacaine; D004837:Epinephrine